Monthly Archives: April 2009

How is it that France manages to have the world’s best health care system (according to the World Health Organization) yet spends no more, as a percentage of national wealth, than the US?

Not only does France’s system rank higher on quality, but it covers all 62m residents, whereas the US census bureau reported in August last year that 45.7m Americans, 15.3 per cent of the population, had no health insurance.

One striking element of the French system is the extent to which it is built upon ‘commercial’ business models. Whereas in the UK, the flow of national insurance contributions into the National Health Service is indistinguishable from taxation, in France health insurance clearly buys treatment.

Sometimes you really do wonder whether the Conservatives are remotely ready for government. The travails of the NHS’s £12.7bn project to create an electronic medical record for all are well known. The health department has just come up with its latest plan to rescue it.

Your guess is as good as mine about whether it will work. But it at least applies to the real world. At the Conservative spring conference at the weekend, David Cameron, the Tory leader, was talking about what he quaintly calls the “NHS supercomputer” as though this was some mighty black box sat in a field somewhere in the middle of England.

Not needed, he said, because “in this age of austerity, a web-based version of the government’s bureaucratic services like Google Health or Microsoft Health Vault cost virtually nothing to run”.

The Conservatives have clearly been listening to snake oil salesmen. Applications like these may well play an important part of patient controlled, and patient accessed, records. But the idea that either of these remotely amount to the patient administration system, appointment booking, test ordering and recording, digital imaging equipment, clinical coding, the decision support systems and the myriad other items needed in a hospital or GP practice to create a full electronic record in the first place is laughable. It really is not a choice between £12.7bn and “virtually nothing”.

The flu strain that is spreading from Mexico and causing alarm about a possible pandemic has generally been called “swine flu” by health authorities, including the World Health Organisation.

But pig producers and animal health experts understandably dislike that term. Not only does it give pigs a bad name (and incidentally damage consumer demand for pork products) but also, they say, it is inaccurate.

In fact the H1N1 virus responsible for the outbreak has not been linked directly to pigs, in Mexico or anywhere else. The virus has not been isolated from any animal apart from humans, though virologists surmise that it may have originated in a pig.

Like birds and people, pigs can act as a “mixing vessels” in which different viruses swap genes and produce a new strain. The Mexican virus appears to contain porcine, avian and human genetic components.

Governments in Europe and Asia stepped up their response to the outbreak of deadly swine flu in the Americas as Spain confirmed it had diagnosed a case and investors sold off travel stocks.

The World Health Organisation brought forward an emergency meeting to Monday to decide whether to raise its alert level in response to the outbreak which has killed 103 people in Mexico and spread to North America.

Governments and health authorities worldwide went on the alert over the weekend for a possible influenza pandemic as the death toll from a new strain of swine flu in Mexico reached 103.Janet Napolitano, homeland security secretary, on Sunday declared a “public health emergency” in the US as about 20 people there were confirmed to have been infected, though none is seriously ill. The World Health Organisation in Geneva had earlier made a similar announcement.

“Whenever we introduce this,” says Clare Dollery, a consultant cardiologist at the Heart Hospital in London, “lots of clinicians come up to me and say, ‘This is the sort of information we have been asking for for years.’ “The information is a set of data showing the clinician team’s activity, its broad costs, whether or not it is making a profit against the tariff – the price the National Health Service pays hospitals per procedure or treatment – plus, crucially, a lot of data on quality.

These are as diverse as infection and readmission rates, length of hospital stay, survival data and, for example, the time elapsed between a heart attack patient arriving and the coronary arteries being opened again, and how that compares with other hospitals both domestically and internationally.

The NHS and the Department of Health took the biggest hit yesterday as the government allocated its £5bn cut in public spending for next year, which it claims will be made up by efficiency savings.The NHS has to make virtually half the savings – £2.3bn – on top of the 3 per cent-a-year savings with which it was already charged. Next year’s budget has been cut from a planned £104.6bn to £102.3bn, but that will still represent £4bn in growth over this year.

Pharmaceutical companies have done better than most in weathering the economic downturn, since health is rather less elastic than most other items of spending.

But the first quarter results season currently underway has shown the sector is far from immune. GSK and Merck are among the latest to show a slump in US sales in figures out this week.

Most of the drop has been the result of one-off events such as patent expiries. Yet there are hints of downturn-related problems too.

So far, much of the impact has been de-stocking by pharmacies and wholesalers. In the US, as more people lose their jobs and insurance cover, demand is likely to suffer with patients unable to take medicines they pay for themselves – or deferring doctors visits to avoid consultation fees.

Likewise in the emerging economies, where many people pay for their own healthcare, the impact of the downturn is also being felt. Diversification away from the vast but slowing US market is certainly not a panacea.

Out of the run of the usual debates at the World Economic Forum on Latin America in Rio de Janeiro this week was a panel discussion entitled Drugs and Democracy: Towards a Paradigm Shift? It was timed to accompany the release of a report from the Latin American Commission on Drugs and Democracy led by former presidents of Colombia, Mexico and Brazil, two of whom – César Gaviria of Colombia and Fernando Henrique Cardoso of Brazil – were on the discussion panel (the third is Ernesto Zedillo of Mexico).

The report repeatedly stresses and illustrates the failure of prohibitionist policies and makes some daring suggestions, the first being to change “the status of addicts from drug buyers in the illegal market to that of patients cared for in the public health system”.

This sounds like a move towards decriminalisation. Other parts of the report point the same way:

Clive Cookson has been a science journalist for the whole of his working life. He joined the FT in 1987. Clive, the FT's science editor, picks out the research that everyone should know about. He also discusses key policy issues, from R&D funding to science education.

Andrew Jack is pharmaceuticals correspondent, covering the industry and public health issues. He has been a journalist with the FT for 19 years, based in London, Paris and Moscow